Giampaolo Perna

Dipartimento di Neuroscienze Cliniche, Casa di Cura San Benedetto Menni, Albese con Cassano (Como)Centro Europeo per i Disturbi d’Ansia ed Emotivi (Milano)

Psicopatologia e fisiopatologia del panico: il tronco encefalico e l’omeostasi fisiopatologica

Sensations of shortness of breathFeeling dizzy, unsteadyPalpitations Trembling or shakingSweatingfeeling of chokingNausea or abdominal distress

A Panic Attack is an acute episode of intense fear or discomfort which develop abruptly, usually lasts few minutes and is characterized by several neurovegetative and cognitive symptoms:

• Feelings of unreality • Paresthesias • Chills or hot flushes• Chest pain or discomfort• Fear of dying• Fear of losing control or going crazy

Defining a Panic Attack

10-15% individuals from general population experience

unexpected panic attacks during their lifetime

3-4% individuals from general population develop Panic Disorder

Panic Attacks and Panic Disorder

Panic March UNEXPECTED PANIC ATTACKS

HYPOCHONDRIA

ANTICIPATORY ANXIETY

PHOBIC AVOIDANCE

DEPRESSION SUBSTANCE ABUSE

SITUATIONAL PANIC ATTACKS

Persistent pathologic fear of having a severe somatic disease

Persistent pathologic fear of having a panic attack

Severe discomfort or avoidance of places and situation where escaping or looking for help might be difficult

Brainstem?………. who matters?

Brain………………………………

………………………..…….. Body

Why has the brainstem been neglected?

1. Higher function in the brain attract incoming students as a prime goal for scientific study

2. Untile recently the braistem was hard to approach experimentally

3. When neurobiology has born, biology of respiratory and cardiovascular system remained in the domain of physiologists

Some clues from this volume dedicated to the brainstem….

1. Brainstem regions controlling cardiovascular and respiratory function are juxtaposed and intermingled.

2. Particularly importanto for respiratory control is serotonin…. As its role in reversing opiate mediated respiratory depression… similarly, brainstem cardiovascular control

3. One essential gene is Phox2b… provides an essential “drive to breath” ……and is also required for the embryological development of the cardiovascular system and central chemosensitivity.

Perhaps, in the future, students of the nervous systemWill discover the fascination of trying to understand How the brainstem performs essential housekeeping

Activities that underlie all the higher functions in the brain.

John Nicholls & Julian Paton

• Emotion is inexorably bound to instict

• Emotion (Websters International Dictionary): physiological departure from homeostasis which is subjectively experienced in strong feeling….. Snd bodily changes preparatory to evrt acts which may or may not be performed

• Primordial Emotions are genetically programmed and guard the physico-chemical constancy of the internal environment of the body – the homeostatic process.

….. Panic attacks are frequent in the off- of parkinson treatment………….

Panic in the Brainstem

back to 1984……?

Increased brainstem volume (ventral and dorsal midbrain and rostral pons)

Decreased frontal (orbitofrontal, right superior frontal gyrus)

Increased volume of:

- Insula sx- Temporal gyrus sx- Brainstem

Abnormal function:

- Prefronta Cortex- ACC- Amygdala - Brainstem

Panic as a Primal Emotion

• Evolution has supplied organisms with a wide collection of mechanisms to mantain internal stability and defence of bodily well being.

• Regulatory physiologic processes take place continuosly beyond consciousness and only occasionally do they pervade the conscious awareness as “primal emotions” (Damasio 1999) with the evolutionary role of signaling that the survival of the organism is threatened